后程超分割放射治疗局部晚期非小细胞肺癌的临床研究  

Clinical study of late-course hyperfractionated radiotherapy in the treatment of local advanced non-small cell lung cancer

作　　者：程晶[1] 伍钢[1] 李勤[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院肿瘤诊疗研究中心,湖北武汉430023

出　　处：《中国癌症杂志》2004年第3期254-257,共4页China Oncology

摘　　要：目的 :探讨后程超分割放疗在局部晚期非小细胞肺癌 (NSCLC)治疗中的作用和毒性。方法 :将 74例Ⅲ期NSCLC患者随机分成 2个组 :(1)常规分割 (CF)组 :2 .0Gy/次 ,5次 /周 ,大野照射至 4 0Gy时 ,缩野针对临床肿瘤区加量照射 ,总剂量为 6 5～ 70Gy/33～ 35次 ;(2 )后程超分割 (LCH)组 :先常规照射 4 0Gy ,后程缩野后 1.2Gy/次 ,2次 /天 ,2次间隔 6小时 ,5天 /周 ,共 10个治疗日 ,照射量 2 4Gy ,总剂量为 6 4Gy/40～ 4 2次。结果 :LCH组和CF组的有效率分别为 78.4 % (2 9/37)和 6 2 .2 % (2 3/37) ,有显著性差异 (P <0 .0 5 ) ;随访 5年 ,LCH组的前 3年局部控制率和生存率分别为 70 .3%、4 8.6 %、2 7.0 %和 75 .7%、5 9.5 %、32 .4 % ,较CF组相应的 5 6 .8%、2 1.6 %、5 .4 %和 6 2 .2 %、2 7.0 %、16 .2 %均有显著性差异 (P <0 .0 5 ) ;但两组的五年生存率无显著性差异。而放疗毒性反应发生率除放射性食管炎外两组无明显差异。结论 :后程超分割放疗能提高局部晚期NSCLC的近期疗效、局控率和生存率 ;Purpose:To evaluate the clinical effect of late-course hyperfractionated (LCH) radiotherapy and conventionally fractionated (CF) radiotherapy for local advanced non-small cell lung cancer (NSCLC). Methods:From August 1995 to April 1998, 74 patients with inoperable stage Ⅲ NSCLC were randomized into two groups: CF and LCH. 37 patients in CF group received a fraction of 2 Gy daily, 5 days per week, to the total dose of 65～70 Gy /6.5～7 weeks. 37 patients in LCH group were treated with the same fractionation as CF group to the dose of 40 Gy, and then followed by LCH radiotherapy: 1.2Gy, twice daily, with the interval of 6 hours between fractions, to the total dose of 64 Gy/6 weeks. Results:The overall response rate in LCH group and CF group were 78.4%(29/37) and 62.2%(23/37) respectively, the difference was significant (P<0.05). The l-,2-,3-year local control rates and survival rates were respectively 70.3%? 48.6%?27.0% and 75.7%?59.5%?32.4% in LCH group, and 56.8%?21.6%?5.4% and 62.2%?27.0%?16.2% in CF group (P<0.05). Howerver, the 5-year survival rates in LCH group and CF group were both 5.4%, there was no difference. The incidence of esophagitis in LCH group was 81.1%(30/37),and in CF group was 54.1%(18/37), P< 0.05. Conclusions:The late-course hyperfractionated radiotherapy can improve the overall response rate, 1～3 year local control rates and survival rates with minimal radiation reactions, but it may not improve the 5-year survival rate.

关 键 词：非小细胞肺癌 后程超分割 放射疗法 晚期 

分 类 号：R734.2[医药卫生—肿瘤] R730.55[医药卫生—临床医学]